Site Navigation

Site Mobile Navigation

Senate Health Care Follies

The first week of debate on the Senate’s health care bill was a depressing mixture of foolish posturing by members of both parties and blatant obstructionism by Republicans. If this is the best the Senate can do, we are in for very rough going.

The Democrats had hoped to start voting on amendments to the bill on Tuesday but ran into such head winds that the first amendments — involving women’s health care and Medicare — were not put to a vote until Thursday. The debate gave new life to overheated claims and misrepresentations.

MAMMOGRAMS AND THE MYTH OF RATIONING The battle over women’s health care emerged after a federal advisory committee recommended recently that younger women should not routinely have mammograms but should first consult with their doctors.

The task force concluded that for women in their 40s, every life saved by mammography would be accompanied by harm to many other women who would undergo surgery, radiation or chemotherapy to remove tumors spotted by mammography that would never have killed them or perhaps even become noticeable.

Some experts agree with the task force, others disagree, but its judgment was seized upon by Republican scaremongers as an example of the kind of “rationing” that would allow government bureaucrats to deny insurance coverage of important health procedures.

In an effort to encourage people to engage in prevention programs that can protect their health, it would actually require that private insurance companies and the Medicare and Medicaid programs provide free coverage for any preventive services that are given a grade of A or B by the United States Preventive Services Task Force. (A group of 16 outside experts, it was created 25 years ago to advise the government on which screening techniques are effective and which are not.)

Since mammograms for women in their 40s got a grade of C, they would not have to be covered without co-payments. Even so, if private insurers or government programs wanted to provide free coverage they could do so, regardless of what the task force said.

That seems sound. But instead of confronting the Republicans’ misrepresentations, the Democrats distanced themselves from the task force.

Senator Barbara Mikulski, Democrat of Maryland, championed an amendment that directed a unit of the Department of Health and Human Services to issue guidelines on what preventive services private insurance plans should provide free to women. Then, prejudging how that agency might rule, she declared that her amendment guaranteed women preventive health screenings and care at no cost, including mammograms.

Since she had not mentioned the much-maligned task force, Senator David Vitter, a Louisiana Republican, offered an amendment to her amendment that directed the government to ignore the task force’s most recent mammography recommendations. With the Vitter language inserted, Senator Mikulski’s amendment was approved by a vote of 61 to 39. A rival Republican amendment that would have left decisions on mammograms mostly to private insurers after consultations with medical groups was then rejected.

This sorry episode does not bode well for reform efforts to rein in spending on other procedures based on sound scientific evidence of their potential benefits and risks for patients.

STILL PLAYING TO THE ELDERLY Insisting that his goal was to protect older Americans, Senator John McCain offered an amendment that would have restored nearly $500 billion in planned cuts in payments to Medicare providers and to overly costly private Medicare Advantage plans that receive unwarranted subsidies.

Democrats are counting on those savings, spread out over 10 years, to help finance coverage for tens of millions of uninsured Americans. The amendment would have effectively killed the reform bill. It was defeated, as it should have been, by a vote of 58 to 42. On Friday, the Democrats beat back another amendment that would have restored the cuts to Medicare Advantage.

There is nothing in the bill that would reduce coverage of services in the traditional fee-for-service Medicare program, though providers might be paid less for providing the services and private plans might eliminate some extra benefits. Nevertheless, the Democrats decided to respond to Republican posturing with a meaningless amendment that nothing in the bill “shall result in the reduction of guaranteed benefits” in Medicare. The amendment was approved 100 to 0.

A PLAN FOR OBSTRUCTIONISM Last week Senator Judd Gregg, Republican of New Hampshire, circulated a memo to his colleagues advising them on how to use the Senate’s arcane procedural rules to “insist on a full, complete and fully informed debate.”

What it really reads like is a manual for obstructing action. Mr. Gregg advises his colleagues to consider such tactics as demanding quorum calls, raising points of order that require debate, and offering an unlimited number of amendments on any subject, which he describes as “the fullest expression” of informed debate.

The Democratic leadership is on notice that it will need to get its own caucus behind a compromise agenda that can be passed by a filibuster-proof majority without much, if any, Republican assistance.

This editorial is a part of a comprehensive examination of the policy challenges and politics behind the debate over health care reform.

A version of this editorial appears in print on December 6, 2009, on page WK9 of the New York edition with the headline: Senate Health Care Follies. Today's Paper|Subscribe